Distribution of human papillomavirus genotypes in women with cervical cancer and cervical intraepithelial neoplasia grade three (CIN 3) in Slovenia

Rak materničnega vratu (RMV) se razvije prek več stopenj predrakavih sprememb in ga je z učinkovitim presejalnim programom mogoče preprečiti oz. odkriti in v zgodnjem stadiju uspešno zdraviti. Spolno prenosljiva okužba z visokotveganimi genotipi človeških virusov papiloma (angl. human papillomavirus, HPV) je nujni dejavnik tveganja za nastanek predrakavih sprememb na materničnem vratu in RMV. Pred uvedbo cepljenja proti HPV smo želeli opredeliti razporeditev genotipov HPV pri bolnicah z RMV in bolnicah s predrakavimi spremembami najvišje stopnje (CIN 3) v Sloveniji. Razporeditev genotipov HPV smo analizirali na 284 vzorcih RMV. HPV dezoksiribonukleinsko kislino (DNK) smo dokazali v 262 od 278 vzorcev RMV (94,2 %). Ugotovili smo, da RMV najpogosteje povzročajo HPV 16, HPV 18 in HPV 33. Razporeditev genotipov HPV smo določili tudi na 261 vzorcih brisov materničnega vratu, odvzetih ženskam s CIN 3. V 253 od 261 vzorcev CIN 3 (96,9 %) smo dokazali prisotnost HPV DNK. V 80,6 % vzorcev smo našli le en visokotvegani genotip, v drugih vzorcih smo našli po več genotipov HPV (2 do 9 genotipov). Pri ženskah s CIN 3 so bili najpogosteje zastopani HPV 16, HPV 31 in HPV 33. Profilaktično cepljenje s trenutno dostopnimi cepivi proti HPV bi lahko preprečilo do 77 % primerov RMV in do 60 % primerov CIN 3 v Sloveniji, ki ju povzročata HPV 16 in HPV 18.Cervical cancer (CC) evolves through several stages of precancerous lesions and can therefore be prevented by means of a screening programif detected at an early stage it can also be efficiently treated. Sexually transmitted infection with oncogenic human papillomavirus (HPV) genotypes has been confirmed to be a single necessary etiological factor for the development of cervical precancerous lesions and CC. In order to assess the potential local benefit of prophylactic HPV vaccination, we established the distribution of HPV genotypes in a representative sample of women with CC and high grade cervical intraepithelial lesions (CIN 3) in Slovenia. HPV DNA was found in 262/278 CC samples (94.2%). HPV 16, HPV 18 and HPV 33 were the HPV genotypes most frequently found in CC samples in Slovenia. HPV DNA was found in 253/261 samples of CIN 3 (96.9%). In 80.6% of the samples infection with a single HPV genotype was found, whereas in other samples more than one HPV genotype was found (2 to 9 HPV genotypes). Prophylactic HPV vaccination with currently available vaccines could theoretically prevent up to 77% of cases of CC and up to 60% of cases of CIN 3 caused by HPV 16 and HPV 18 in Slovenia

Slovenska priporočila za rabo nujne kontracepcije

Nujna kontracepcija (KC) je kontracepcija za zaščito pred neželeno nosečnostjo neposredno po nezaščitenem spolnem odnosu kot izhod v sili. Na voljo sta dve metodi nujne KC: oralna nujna KC in nujna vstavitev materničnega vložka z bakrom. V priporočilih so pojasnjene indikacije za nujno KC, vrste nujne KC, mehanizem delovanja, učinkovitost nujne KC ter previdnostni ukrepi, medsebojno delovanje z zdravili in neželeni učinki. Posebej je predstavljeno svetovanje nujne KC ter raba nujne KC pri različnih stanjih in boleznih žensk. Slovenska priporočila za rabo nujne KC povzemajo mednarodna priporočila in vključujejo prilagoditve za naše razmere

Unus pro omnibus, omnes pro uno: A novel, evidence-based, unifying theory for the pathogenesis of endometriosis

The theory of retrograde menstruation as aetiopathogenesis of endometriosis formulated by John Sampson in 1927 shows clear shortcomings: this does not explain why retrograde menstruation is a physiological process that affects 90% of women, while endometriosis occurs in only 10% of cases; it also does not explain the endometriotic foci distant from the pelvis, nor explains the cases of endometriosis in male patients. The immunological alterations of the peritoneal fluid explains the effects of disease, such as the inhibition of the physiological processes of cytolysis, but does not explain the cause. There is evidence to support the hypothesis that ectopic müllerian remnants of the endometrium, endocervix and endosalpinx are items from the genital ridge leaked during organogenesis. It is known that tissues derived from coelomatic epithelial and mesenchymal cells have the potential to metaplastically differentiate into epithelium and stroma. In addition, the phenotype of the ectopic endometrial cells is significantly different from those ectopic. There is scientific evidence that, during organogenesis, the genes of the Homeobox and Wingless family play a fundamental role in the differentiation of the ducts of Muller and development of the anatomical structure of the urogenital tract. We present here a hypothesis that deregulation of genes and the Wnt signaling pathway Wnt/β-catenin leads to aberrations and deregulation within the mesoderm, thus, may cause aberrant placement of stem cells. In addition, immune cells, adhesion molecules, extracellular matrix metalloproteinase and pro-inflammatory cytokines activate/alter peritoneal microenvironment, creating the conditions for differentiation, adhesion, proliferation and survival of ectopic endometrial cells

Impact of multiple sclerosis on infertility and impact of infertility treatments on multiple sclerosis relapses in Slovenia: medical outline, legal and ethical outcomes

Multiple sclerosis (MS) is an autoimmune inflammatory disorder of the central nervous system. It is common in the reproductive period and can lead to infertility and significant disability. The treatment on multiple sclerosis is recently more successful and enables better quality of life, therefore rising hope and desire for the future parents, also in terms of successful infertility treatments. In this context the couples should be managed concerning the detrimental effect of the disease itself on fertility, detrimental effect of the drugs used for treatment on gonads and in terms of the implementation of drugs used for ovarian stimulation and their impact on the basic disease (MS). Article finds solutions on the legal outcomes in situations where infertility treatments may negatively impact the progress of MS, as well as the solutions on how to (successfully) provide infertility treatments to the patients with MS. It proposes interdisciplinary approach between gynecologists and neurologists to perform required weighting of benefits and risks (burdens), deriving from specific action or treatment, whereas for the patients who shall not undergo infertility treatments due to their medical status, related to MS, it proposes storage of gametes under conditions, set by the law

Razporeditev genotipov človeških virusov papiloma pri bolnicah z rakom materničnega vratu in cervikalno intraepitelijsko neoplazijo tretje stopnje (CIN 3) v Sloveniji

Cervical cancer (CC) evolves through several stages of precancerous lesions and can therefore be prevented by means of a screening program; if detected at an early stage it can also be efficiently treated. Sexually transmitted infection with oncogenic human papillomavirus (HPV) genotypes has been confirmed to be a single necessary etiological factor for the development of cervical precancerous lesions and CC. In order to assess the potential local benefit of prophylactic HPV vaccination, we established the distribution of HPV genotypes in a representative sample of women with CC and high grade cervical intraepithelial lesions (CIN 3) in Slovenia. HPV DNA was found in 262/278 CC samples (94.2%). HPV 16, HPV 18 and HPV 33 were the HPV genotypes most frequently found in CC samples in Slovenia. HPV DNA was found in 253/261 samples of CIN 3 (96.9%). In 80.6% of the samples infection with a single HPV genotype was found, whereas in other samples more than one HPV genotype was found (2 to 9 HPV genotypes). Prophylactic HPV vaccination with currently available vaccines could theoretically prevent up to 77% of cases of CC and up to 60% of cases of CIN 3 caused by HPV 16 and HPV 18 in Slovenia.Rak materničnega vratu (RMV) se razvije prek več stopenj predrakavih sprememb in ga je z učinkovitim presejalnim programom mogoče preprečiti oz. odkriti in v zgodnjem stadiju uspešno zdraviti. Spolno prenosljiva okužba z visokotveganimi genotipi človeških virusov papiloma (angl. human papillomavirus, HPV) je nujni dejavnik tveganja za nastanek predrakavih sprememb na materničnem vratu in RMV. Pred uvedbo cepljenja proti HPV smo želeli opredeliti razporeditev genotipov HPV pri bolnicah z RMV in bolnicah s predrakavimi spremembami najvišje stopnje (CIN 3) v Sloveniji. Razporeditev genotipov HPV smo analizirali na 284 vzorcih RMV. HPV dezoksiribonukleinsko kislino (DNK) smo dokazali v 262 od 278 vzorcev RMV (94,2 %). Ugotovili smo, da RMV najpogosteje povzročajo HPV 16, HPV 18 in HPV 33. Razporeditev genotipov HPV smo določili tudi na 261 vzorcih brisov materničnega vratu, odvzetih ženskam s CIN 3. V 253 od 261 vzorcev CIN 3 (96,9 %) smo dokazali prisotnost HPV DNK. V 80,6 % vzorcev smo našli le en visokotvegani genotip, v drugih vzorcih smo našli po več genotipov HPV (2 do 9 genotipov). Pri ženskah s CIN 3 so bili najpogosteje zastopani HPV 16, HPV 31 in HPV 33. Profilaktično cepljenje s trenutno dostopnimi cepivi proti HPV bi lahko preprečilo do 77 % primerov RMV in do 60 % primerov CIN 3 v Sloveniji, ki ju povzročata HPV 16 in HPV 18

SERUM AND FOLLICULAR ENDOCRINE PROFILE DIFFERENCES BETWEEN MODIFIED NATURAL CYCLES AND STIMULATED CYCLES

Background. It has been found that higher follicular anti-müllerian hormone (AMH) concentrations predict higher fertilization, implantation and pregnancy rates in women undergoing controlled ovarian hyperstimulation (COH). 1, 2 Higher serum luteinizing hormone (LH) concentration may negatively affect oocyte quality.3 The aim of our study was to compare follicular and serum AMH, LH, follicle-stimulating hormone (FSH), estradiol (E2) and progesterone (P) concentrations in modified natural cycles (MNC) and COH cycles. Methods. Women undergoing in vitro fertilization (IVF) were included; 29 in MNC and 30 in COH cycles with gonadotropin and GnRH antagonist. Serum and follicular fluid samples were obtained on the day of oocyte retrieval. Results. Follicular AMH concentration was 2 times higher in MNC than in COH group, while serum AMH concentrations were comparable in both groups. Serum LH concentration was almost 50 times higher and follicular LH concentration almost 8 times higher in MNC than in COH group. Follicular LH concentration was almost 4 times lower in follicles with consequent implantation than in follicles without implantation. Serum and follicular concentrations of AMH and LH correlated with each other in both cycle groups. In COH group, serum AMH concentration was significantly higher with increasing number of retrieved oocytes and significantly lower with women’s advancing age. In MNC group, there was a negative correlation between follicular AMH concentration and volume of follicular aspirate as well as between serum LH concentration and volume of follicular aspirate. Serum FSH concentration was 2 times higher in MNC than in COH group, while follicular FSH concentrations were comparable in both groups. Serum E2 concentration was in MNC 8 times lower and follicular E2 concentration 2 times higher than in COH group. Serum P concentration was 8 times lower in MNC than in COH group, while follicular P concentrations were comparable in both groups. Conclusions. The results of our study indicate that serum and follicular endocrine profile is different in MNC and in COH cycles. Extremely high follicular and serum LH concentration in MNC might affect endometrial receptivity and thus have negative effect on IVF success. Higher serum AMH concentration can predict higher number of retrieved oocytes in COH group